Healthcare Provider Details

I. General information

NPI: 1396294336
Provider Name (Legal Business Name): JESSICA MCGEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15238 N 1090 EAST RD
CATLIN IL
61817-9263
US

IV. Provider business mailing address

15238 N 1090 EAST RD
CATLIN IL
61817-9263
US

V. Phone/Fax

Practice location:
  • Phone: 217-260-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number041.368487
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014853
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209014853
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: